U.S. patent number 10,016,265 [Application Number 15/156,627] was granted by the patent office on 2018-07-10 for endoscopic system for winding and inserting a mesh.
This patent grant is currently assigned to Covidien LP. The grantee listed for this patent is Covidien LP. Invention is credited to Gregory Fischvogt, Jeremy Griffin, Jacqueline Jones, Timothy Sargeant.
United States Patent |
10,016,265 |
Griffin , et al. |
July 10, 2018 |
Endoscopic system for winding and inserting a mesh
Abstract
An endoscopic system for winding and inserting a mesh into an
abdominal cavity of a patient is provided. The endoscopic system
includes an introducer having an elongated shaft extending distally
therefrom. The shaft includes a split portion that defines an
opening therealong. The split portion is configured to support the
mesh within the opening. A furler defining a lumen is engageable
with the split portion of the shaft and configured to exert a
radial force onto the mesh that is supported by the split portion.
Rotation of one of the furler and introducer with respect to the
other winds the mesh inside the furler to a diameter smaller than a
diameter of the lumen of the furler.
Inventors: |
Griffin; Jeremy (Hamden,
CT), Jones; Jacqueline (Hamden, CT), Sargeant;
Timothy (Guilford, CT), Fischvogt; Gregory (Hamden,
CT) |
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
CT |
US |
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|
Assignee: |
Covidien LP (Mansfield,
CT)
|
Family
ID: |
53367049 |
Appl.
No.: |
15/156,627 |
Filed: |
May 17, 2016 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20160256253 A1 |
Sep 8, 2016 |
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Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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14455109 |
Jul 29, 2014 |
9364311 |
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61915730 |
Dec 13, 2013 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61F
2/0063 (20130101); A61F 2002/0072 (20130101) |
Current International
Class: |
A61B
17/08 (20060101); A61F 2/00 (20060101) |
Field of
Search: |
;606/1,151
;623/1.11 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Shi; Katherine M
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a divisional of U.S. patent application Ser.
No. 14/445,109 filed Jul. 29, 2014, which claims the benefit of and
priority to U.S. Provisional Patent Application No. 61/915,730,
filed Dec. 13, 2013, the entire disclosure of which is incorporated
by reference herein.
Claims
What is claimed is:
1. A method for inserting a mesh into an abdominal cavity of a
patient, comprising: providing an endoscopic system for winding and
inserting the mesh into the abdominal cavity of the patient, the
endoscopic system including: an introducer having an elongated
shaft extending distally therefrom, the shaft including a split
portion defining an opening therealong; and a furler defining a
lumen and being engageable with the split portion of the shaft and
configured to exert a radial force onto the mesh that is supported
by the split portion; positioning the mesh through the split
portion of the shaft; positioning the furler over the split portion
of the shaft to at least partially cover the mesh; rotating one of
the furler and the shaft with respect to the other to wind the mesh
inside the furler; applying a radial force to the mesh, by reducing
a diameter of the furler, as the mesh is being wound in the furler;
and inserting the furler and the wound mesh through an access
opening in the patient.
2. The method according to claim 1, further comprising pushing the
shaft distally in relation to the access opening to engage a
proximal end of the furler with the access opening to position the
mesh into the abdominal cavity of the patient and unwind the
mesh.
3. The method according to claim 1, wherein positioning the mesh
through the split portion of the shaft further includes positioning
the mesh within the opening that extends along the split portion of
the shaft.
4. The method according to claim 1, wherein, prior to positioning
the furler over the split portion of the shaft to at least
partially cover the mesh, folding the mesh over the split portion
of the shaft and positioning at least a portion of the folded mesh
within a longitudinal slit of the furler.
5. The method according to claim 1, wherein rotating one of the
furler and the shaft with respect to the other to wind the mesh
inside the furler further includes depressing a tabbed cut-out of
the furler to apply the radial force to the mesh as the mesh is
being wound, thereby facilitating a tight wind of the mesh and
preventing unwinding of the mesh.
6. The method according to claim 1, wherein the furler has an
elongated configuration.
7. The method according to claim 1, receiving the mesh on a
longitudinal slit of the furler when the mesh is supported on the
split portion of the shaft.
8. The method according to claim 1, wherein the furler includes a
tapered-down distal end defined by a v-shaped opening.
9. The method according to claim 1, wherein the furler includes a
flared proximal end having a conical configuration.
10. The method according to claim 1, wherein the furler includes a
medial portion having a tabbed cut-out defined by three side walls
and a living hinge.
11. The method according to claim 10, further comprising depressing
the tabbed cut-out to reduce the diameter of the lumen of the
furler and applying a normal force to the mesh as the mesh is being
wound within the furler.
12. The method according to claim 1, wherein the furler includes a
pair of tension tabs extending radially from a center of the
furler.
13. The method according to claim 1, wherein the furler includes a
pair of tension tabs extending tangentially from a center of the
furler.
14. The method according to claim 13, wherein prior to positioning
the furler over the split portion of the shaft to at least
partially cover the mesh, positioning a sheath proximally in
relation to the split portion.
15. The method according to claim 14, wherein after mesh is wound,
positioning the sheath over the split portion of the shaft.
16. The method according to claim 15, further comprising inserting
the wound mesh and the sheath through an access opening in the
patient.
17. The method according to claim 1, wherein the shaft includes an
articulating portion positioned proximally in relation to the split
portion.
18. The method according to claim 1, wherein the opening of the
split portion extends to a distal tip of the shaft.
Description
BACKGROUND
Technical Field
The present disclosure relates to an endoscopic system for winding
and inserting mesh. More particularly, the present disclosure
relates to an endoscopic system including an introducer and furler
configured to wind and insert a mesh into an abdominal cavity of a
patient.
Description of Related Art
Current mesh application typically requires a scrub nurse or other
operating room personal to open, at the operating table, a
pre-packaged sterile container containing a mesh, which may have a
flat configuration. A surgeon will often remove the mesh from the
opened container and mark the mesh with a marker and then roll or
wind the mesh (e.g., like a scroll). The wound mesh is inserted
into an abdominal cavity of a patient through an access port, e.g.,
a large diameter port (10 or 12 mm trocar) or through an open port
site from which a trocar has been removed. In the latter case,
after the mesh is inserted into the abdominal cavity, the trocar
may be reinserted into the open port site to reenter the abdominal
cavity. This additional step of reinserting the trocar adds time to
the surgical procedure and can sometimes be difficult because of
tissue plane movement.
While the aforementioned method for winding and inserting a mesh
into an abdominal cavity of a patient may be satisfactory, a need
exists for a simpler and less time-consuming method.
SUMMARY
As can be appreciated, an endoscopic instrument including an
introducer and furler configured to wind (or roll) and insert a
mesh into an abdominal cavity may prove useful in the surgical
arena.
Embodiments of the present disclosure are described in detail with
reference to the drawing figures wherein like reference numerals
identify similar or identical elements. As used herein, the term
"distal" refers to the portion that is being described which is
further from a user, while the term "proximal" refers to the
portion that is being described which is closer to a user.
An aspect of the present disclosure provides an endoscopic system
for winding and inserting a mesh into an abdominal cavity of a
patient. The endoscopic system includes an introducer having an
elongated shaft extending distally therefrom. The shaft includes a
split portion that defines an opening therealong. The opening of
the split portion may extend to a distal tip of the shaft. The
split portion is configured to support the mesh within the opening.
A furler defining a lumen is engageable with the split portion of
the shaft and configured to exert a radial force onto the mesh that
is supported by the split portion. Rotation of one of the furler
and introducer with respect to the other winds the mesh inside the
furler to a diameter smaller than a diameter of the lumen of the
furler.
The furler may be movable along the shaft to at least partially
cover the mesh when the mesh is positioned within the split portion
of the shaft. The furler may have an elongated configuration and a
longitudinal slit extending along a length thereof. The
longitudinal slit of the furler may be configured to receive the
mesh when the mesh is supported on the split portion of the
shaft.
The furler may include a tapered-down distal end defined by a
v-shaped opening. The furler may include a flared proximal end
having a conical configuration. The furler may include a medial
portion having a tabbed cut-out defined by three side walls and a
living hinge. The tabbed cut-out may be depressible to reduce the
diameter of the lumen of the furler and apply the radial force to
the mesh as the mesh is being wound.
The furler may include a pair of tension tabs extending radially
from a center of the furler. Alternatively, the furler may include
a pair of tension tabs extending tangentially from a center of the
furler.
The shaft of the introducer may include an articulating portion
positioned proximally in relation to the split portion. The
endoscopic system may also include a sheath which is movable along
the shaft and slidable within the furler.
Another aspect of the present disclosure provides a method that
utilizes the endoscopic system for inserting a mesh into an
abdominal cavity of a patient. The mesh is, initially, positioned
through the split portion of the shaft. The furler, is then
positioned over the split portion of the shaft to at least
partially cover the mesh. Thereafter, one of the furler and shaft
is rotated with respect to the other to wind the mesh inside the
furler. A radial force is applied to the mesh, by reducing the
diameter of the furler, as the mesh is being wound in the
furler.
The furler including the wound mesh may then be inserted through an
access opening in a patient. Further, the shaft may be pushed
distally in relation to the access opening to engage a proximal end
of the furler with the access opening to position the mesh into the
abdominal cavity of a patient and unwind the mesh.
Positioning the mesh through the split portion of the shaft may
further include positioning the mesh within the opening that
extends along the split portion of the shaft. Moreover, prior to
positioning the furler over the split portion of the shaft to at
least partially cover the mesh, the mesh may be folded over the
split portion of the shaft and at least a portion of the folded
mesh may be positioned within the longitudinal slit of the furler.
Rotating one of the furler and shaft with respect to the other to
wind the mesh inside the furler may further include depressing the
tabbed cut-out of the furler to apply the radial force to the mesh
as the mesh is being wound, thereby facilitating a tight wind of
the mesh and preventing unwinding of the mesh.
BRIEF DESCRIPTION OF THE DRAWING
Various embodiments of the present disclosure are described
hereinbelow with references to the drawings, wherein:
FIG. 1A is a perspective view of an endoscopic system including an
introducer, a furler and a mesh according to an embodiment of the
instant disclosure;
FIG. 1B is a perspective view of the endoscopic system shown in
FIG. 1A with parts separated;
FIG. 2 is a perspective view of the introducer shown in FIGS. 1A
and 1B;
FIG. 3A is a perspective view of the furler shown in FIGS. 1A and
1B;
FIG. 3B is a partial, perspective view of a furler according to an
alternate embodiment of the instant disclosure;
FIG. 4 is an indicated area of detail shown in FIG. 3A;
FIG. 5 is an indicated area of detail shown in FIG. 3A;
FIG. 6 is an indicated area of detail shown in FIG. 3A;
FIGS. 7-11 are perspective views illustrating a method of use of
the endoscopic system shown in FIG. 1A;
FIG. 12 is a perspective view of an endoscopic system including an
introducer, a furler and a mesh according to another embodiment of
the instant disclosure;
FIG. 13 is a perspective view of the furler shown in FIG. 12;
FIG. 14 is a perspective view of a furler according to another
embodiment of the instant disclosure; and
FIGS. 15-18 are perspective views illustrating a method of use of
the endoscopic system shown in FIG. 12.
DETAILED DESCRIPTION
Detailed embodiments of the present disclosure are disclosed
herein; however, the disclosed embodiments are merely examples of
the disclosure, which may be embodied in various forms. Therefore,
specific structural and functional details disclosed herein are not
to be interpreted as limiting, but merely as a basis for the claims
and as a representative basis for teaching one skilled in the art
to variously employ the present disclosure in virtually any
appropriately detailed structure.
As discussed above, an endoscopic system including an introducer
and furler configured to wind (or roll) and insert a mesh into an
abdominal cavity of a patient may prove useful in the surgical
arena, and such an endoscopic system is described herein.
FIGS. 1A and 1B illustrate an endoscopic system 10 that includes an
introducer 12 and a furler 14 which are configured to wind and
insert one or more types of mesh 16 into an abdominal cavity of a
patient. Suitable meshes include, but are not limited to, mesh that
are formed via casting, molding, needle-punching, hooking, weaving,
rolling, pressing, bundling, braiding, spinning, piling, knitting,
felting, drawing, splicing, cabling, extruding, and/or combinations
thereof. In some embodiments, the mesh 16 may further include
reactive and/or may be bioabsorbable or non-bioabsorbable. The mesh
16 may have a thickness of from about 0.2 mm to about 5 mm, in
embodiments, from about 1 mm to about 3 mm. Strands of the mesh 16
may be spaced apart to form pores of from about 100 microns to
about 2000 microns in diameter, in embodiments, from about 200
microns to about 1500 microns, in other embodiments, from about 750
microns to about 1250 microns in diameter. Examples of various
meshes include those disclosed in U.S. Pat. Nos. 6,596,002;
6,408,656; 7,021,086; 6,971,252; 6,695,855; 6,451,032; 6,443,964;
6,478,727; 6,391,060; and U.S. Patent Application Publication No.
2007/0032805, the entire disclosures of each of which are
incorporated by reference herein.
Filaments of the mesh 16 may be monofilament or multi-filament.
Where multi-filament constructs are utilized, they may be plaited,
braided, weaved, twisted, and the like, or laid parallel to form a
unit for further construction into a fabric, textile, patch, mesh,
and the like. The distribution of the filaments or strands may be
random or oriented.
The mesh 16 may include natural or synthetic, bioabsorbable or
non-bioabsorbable materials including those listed below. Suitable
meshes include a collagen composite mesh such as PARIETEX.TM. (Tyco
Healthcare Group LP, d/b/a Covidien, North Haven, Conn.) may be
used. PARIETEX.TM. Composite mesh is a 3-dimensional polyester
weave with a resorbable collagen film bonded on one side.
In embodiments, the mesh 16 component may be a substantially flat
sheet (as described in the illustrated embodiments). In other
embodiments, the mesh 16 may be cylindrical in shape.
In embodiments, the mesh 16 may act as a tissue scaffold, thereby
providing a means for tissue integration/ingrowth. Such meshes are
capable of providing cells with growth and development components.
Thus, where a mesh is utilized as a tissue scaffold, it may assist
in native tissue regrowth by providing the surrounding tissue with
needed nutrients and bioactive agents. In some embodiments, as
discussed herein, the mesh 16 itself may include a natural
component, such as collagen, gelatin, hyaluronic acid, combinations
thereof, and the like, and thus the natural component may be
released or otherwise degrade at the site of implantation as the
tissue scaffold degrades.
Continuing with reference to FIGS. 1A and 1B, the endoscopic system
10 may include or be utilized with one or more suitable access
ports (e.g., trocar or radial sleeve with access openings ranging
from about 5 mm to about 15 mm) to access the abdominal cavity of a
patient to insert a wound mesh 16. Alternatively, the endoscopic
system 10 can be utilized to insert the wound mesh 16 directly into
the abdominal cavity through an incision in a patient.
FIG. 2 is a perspective view of the introducer 12. The introducer
12 includes a generally elongated configuration and has a handle
18, which may be ergonomically shaped to facilitate grasping and
rotation of the introducer 12. In the illustrated embodiments, for
example, a plurality of rib portions 20 are provided along a length
of the handle 18 of the introducer 12 to facilitate grasping and
rotation of the introducer 12.
Continuing with reference to FIG. 2, a shaft 22 extends from the
handle 18 of the introducer 12. In the illustrated embodiments, the
shaft 22 includes a first shaft portion 24 that extends distally
from a distal end of the handle 18. The first shaft portion 24
connects to or supports an articulating or flexing portion 26
(shown schematically in FIG. 2) from which a second shaft portion
28 extends distally. The second shaft portion 28 pivotally connects
to the articulating or flexing section 26 so that the second shaft
portion 28 can be moved to one or more articulated or flexed
configurations for positioning the mesh 16 within the abdominal
cavity of a patient. In embodiments, the first and second shaft
portions 24, 28 can be directly coupled to one another and the
articulating or flexing portion 26 may be omitted.
The first shaft portion 24 has a generally elongated, cylindrical
configuration and is configured to support the furler 14. The first
shaft portion 24 has an outer diameter that allows the furler 14 to
be moved along the first shaft portion 24 and over the mesh 16,
which mesh 16 will be secured to or hung on the second shaft
portion 28 and in a folded configuration, described in detail
below. During insertion of the second shaft portion 28 into an
access opening to insert the wound mesh 16 into the abdominal
cavity, due to the size of the outer diameter of the first shaft
portion 24, the furler 14 is able to move along the first shaft
portion 24 to release the mesh 16 from the second shaft portion 28,
also described in detail below.
The second shaft portion 28 may take the form of a splined shaft
including two tines 30a, 30b that extend along a length of the
second shaft portion 28. The two tines 30a, 30b are spaced-apart
from one another and define a longitudinal opening 32 therebetween
to form a fork or split configuration. The longitudinal opening 32
extends to a distal tip 34 that is configured to receive the mesh
16 so that the mesh 16 can be temporarily secured between the two
tines 30a, 30b of the introducer 12.
In one method of use, once the mesh 16 is inserted between the two
tines 30a, 30b of the introducer 12, the mesh 16 can be folded over
the two tines 30a, 30b and the furler 14 can be positioned along
the two tines 30a, 30b to cover the mesh 16, which can then be
wound within the furler 14. Thereafter, the wound mesh 16 can be
inserted into the abdominal cavity of a patient where the mesh 16
can be positioned adjacent target tissue with the articulating
section 26 and/or released from between the tines 30a, 30b through
the opening 32.
The introducer 12 including the handle 18 and first and second
shaft portions 24, 28 may be formed from any suitable material,
e.g., plastic, metal, ceramic, etc. For example, in embodiments,
the handle 18 and first shaft portion 24 may be formed from a
relatively rigid plastic and the tines 30a, 30b of the second shaft
portion 28 may be formed from surgical steel. If the articulating
portion 26 is provided with the introducer 12, the articulating
portion 26 can be formed from plastic and/or surgical steel.
Turning now to FIGS. 3A and 4-6, the furler 14 is illustrated and
will be described. The furler 14 can be formed from the same
materials used to form the introducer 12. In the illustrated
embodiments, the furler 14 may be formed from a relatively rigid
plastic or stainless steel.
The furler 14 has a generally tubular configuration including
proximal and distal ends 36, 38, respectively, and a medial portion
46 extending therebetween. Extending along the medial portion 46 of
the furler 14 from the proximal end 36 to the distal end 38 is a
longitudinal slot 37. The longitudinal slot 37 is configured to
receive the mesh 16 when the mesh 16 is folded over the tines 30a,
30b so that the mesh 16 can be inserted into the furler 14 and
wound.
Referring to FIG. 4, the proximal end 36 includes a flared neck
portion 40 that tapers outwardly to define an opening or lumen 42,
which extends through the furler 14. The flared neck portion 40 has
a conical configuration and includes a diameter that is greater
than a diameter of the medial portion 46 and the distal end 38. The
diameter of the flared neck portion 40 is also greater than a
diameter of a proximal end of the access opening. This difference
in diameter causes interference between the proximal end of the
access opening and the flared neck portion 40 of the furler 14,
which prevents the furler 14 from passing through the access
opening as the second shaft portion 28 is being pushed distally
therethrough to insert the wound mesh 16 into the abdominal cavity.
Accordingly, the force that a user is applying to the introducer 12
after the flared neck portion 40 engages the proximal end of the
access opening overcomes the frictional force between the wound
mesh 16 and the furler 14 causing the wound mesh 16 to exit the
furler 14 into the abdominal cavity of the patient. Additionally,
the flared neck portion 40 provides a guide or funnel-like
structure to facilitate alignment and insertion of the distal tip
34 of the second shaft portion 28 into the furler 14.
Referring to FIG. 5, the distal end 38 of the furler 14 includes a
tapered down configuration having a generally v-shaped opening 44,
which facilitates sliding the distal end 38 over the mesh 16 when
the mesh 16 is folded over the tines 30a, 30b of the second shaft
portion 28. The tapered down distal end 38 of the furler 14 also
facilitates inserting the distal end 38 of the furler 14 into the
access opening. The distal end 38 of the furler 14 may include
other configurations not disclosed herein.
Referring to FIG. 6, the medial portion 46 of the furler 14
includes a tabbed cut-out 48 defined by three side walls 50a-50c
and a living hinge 52, which allows the tabbed cut-out 48 to be
depressed by a user to apply a radial force "F" normal or
perpendicular (FIGS. 6 and 8) to the mesh 16 as the mesh 16 is
being wound.
More particularly, in one embodiment of use, the tabbed cut-out 48
can be depressed and held by the user to effectively decrease the
inside diameter of the furler 14 (i.e., to decrease a diameter of
the lumen 42) to a point where the tabbed cut-out 48 comes into
contact with the mesh 16. As the mesh 16 is being wound, and
increasing in diameter within the furler 14, the tabbed cut-out 48
follows an outside diameter of the mesh 16 such that the
application of the radial force "F" to the mesh 16 provides a tight
wind of the mesh 16 (and prevents unwinding of the mesh 16). The
tightly wound mesh 16 can be inserted into the abdominal cavity of
the patient through a relatively smaller access opening, e.g.,
trocar with 5 mm opening, as compared to a wound mesh 16 that has
not been more tightly wound due to the use of tabbed cut-out
48.
In embodiments, the tabbed cut-out 48 can be omitted and the furler
14 can be provided with a window 47 (FIG. 3B). In one embodiment of
use, a user can position their thumb (or one of their fingers)
within the window 47 to apply a radial force "F" normal or
perpendicular to the mesh 16 as the mesh 16 is being wound to
effectively decrease the inside diameter of the furler 14 (i.e., to
decrease a diameter of the lumen 42) to a point where the user's
thumb comes into contact with the mesh 16. As the mesh 16 is being
wound, and increasing in diameter within the furler 14, the user's
thumb follows an outside diameter of the mesh 16 such that the
application of the radial force "F" to the mesh 16 provides a tight
wind of the mesh 16 (and prevents unwinding of the mesh 16). The
tightly wound mesh 16 can be inserted as described above.
Referring to FIGS. 7-11, a method of use of the endoscopic system
10 is now described. The components of the endoscopic system 10 may
be packaged and shipped (in a sterile environment) separately, or
together as a kit. In the latter instance, for example, the kit may
include one or more of the aforementioned radial sleeves or trocar,
the introducer 12, the furler 14 and the mesh 16. Conversely, the
kit may be sold without the radial sleeves or trocar.
According to one embodiment of use, the furler 14 is, initially,
positioned on the first shaft portion 24 towards the handle 18,
with the tines 30a, 30b exposed (see FIG. 1A for example) or
extending distally of the furler 14. The mesh 16 may be placed flat
between the tines 30a, 30b, with the tines 30a, 30b in the center
of the mesh 16. It is noted, the mesh 16 can be provided with a
center-line "CL" to facilitate positioning the mesh 16 between the
tines 30a, 30b (see FIG. 1B for example). The mesh 16 is then
folded in half along the tines 30a, 30b (FIG. 7). In embodiments,
such as when the endoscopic system 10 is sold as a kit, the mesh 16
can be pre-positioned between the tines 30a, 30b of the second
shaft portion 28 and pre-wound within the furler 14.
The furler 14 is then slid distally along the first and second
shaft portions 24, 28 with the longitudinal slot 57 of the furler
14 aligning with the folded mesh 16 so that the furler 14 covers
the tines 30a, 30b with the two halves of the mesh 16 hanging out
of the longitudinal slot 57 thereof (FIG. 7). It is noted that the
furler 14 may be positioned completely or partially over the mesh
16 to wind the mesh 16.
In one hand a surgeon holds the furler 14, and with the other hand
rotates the handle 18 of the introducer 12, thereby rolling or
winding the mesh 16 within the furler 14 (FIG. 8). Alternatively,
the handle 18 of the introducer 12 can be held while the furler 14
is rotated with respect to the handle 12. In either instance, the
tabbed cut-out 48 can be depressed as the mesh 16 is being wound in
the furler 14 to provide a tight wind of the mesh 16. Desirably,
the introducer 12 is rotated in a direction toward the sidewall 50b
of the tabbed cut-out 48 (see FIG. 6) of the furler 14. Once the
mesh 16 is fully wound, the introducer 12 including the furler 14
with the wound mesh 16 is inserted into a trocar 54 (FIG. 9).
The furler 14 acts as a sheath which protects the mesh 16 as the
mesh 16 is being inserted through the trocar 54. As the introducer
12 is being inserted into the trocar 54, the flared neck 40 on the
proximal end 36 of the furler 14 contacts the proximal end of the
trocar 54 preventing the furler 14 from going past a proximal end
of the trocar 54 and completely entering the trocar 54 (FIG. 10).
As the surgeon continues to insert the introducer 12 via the handle
18, the tines 30a, 30b advance the mesh 16 past the furler
14/trocar 54 and into the abdominal cavity of the patient, where
the mesh 16 naturally unwinds (FIG. 10). At this point the surgeon
can use the introducer 12 to roughly position (e.g., via the
articulating portion 26 of the introducer 12) the mesh 16 for
initial tacking, or simply remove the introducer 12, thereby
allowing the mesh 16 to gently drop into the abdominal cavity (FIG.
11).
In accordance with the instant disclosure, the endoscopic system 10
allows for tight winding of the mesh 16 so that the mesh 16 can be
inserted through trocars or radial sleeves that include relatively
small access openings (e.g., 5 mm). As can be appreciated, this
allows the surgeon to use smaller access ports, which, in turn, may
prevent port site herniation and post-operative pain typically
associated with larger port sites. Additionally, the furler 14
protects the mesh 16 from prematurely coming in contact with skin
or underlying tissue.
From the foregoing and with reference to the various figure
drawings, those skilled in the art will appreciate that certain
modifications can also be made to the present disclosure without
departing from the scope of the same. For example, the flared neck
portion 40 of the furler 14 is one of many ways to create a stop
that prevents the furler 14 from completely entering the access
opening. For example, any number of tube forming operations could
be utilized to achieve the same function. In embodiments, a flange
(not shown) can be provided along an exterior surface of the furler
14 or a tab that extends radially outward from the furler 14 can
also be used to create a stop that prevents the furler 14 from
completely entering and/or exiting the access opening.
In embodiments, the introducer 12 may be provided with a pin or
other suitable device (not explicitly shown) that aligns with the
longitudinal slot 37 on the furler 14 to engage the longitudinal
slot 37, thereby preventing the furler 14 from coming off of the
introducer 12 upon removal from the access opening.
In embodiments, the handle 18 of the introducer 12 can have a
trigger or button (not explicitly shown) for automatic
deployment/unwrapping of the mesh 16, or can be powered to
dispense/unravel/unwind the mesh 16 intra-abdominally with the push
of the button.
Referring to FIG. 12 an endoscopic system 110 in accordance with
another embodiment of the present disclosure is illustrated. The
endoscopic system 110 is similar to the endoscopic system 10.
Accordingly, only those components and operative features that are
unique to the endoscopic system 110 are described herein.
The endoscopic system 110 includes a sheath 113 that is
positionable along a first and second shaft portions 124, 128 of an
introducer 112.
The endoscopic system 110 includes a furler 114 that is
substantially similar to the furler 14 (FIG. 13). Unlike the furler
14, however, the furler 114 illustrated in FIG. 13 is not an
"in-line" furler as the furler 14. In other words, the furler 114
is not configured to remain attached to the introducer 112 when a
mesh 116 is being inserted through an access port, e.g., the trocar
54. Accordingly, the furler 114 need not include the flared neck
portion 40, as this feature (e.g., a flared neck portion 140) is
provided on the sheath 113 (see FIG. 12).
As illustrated in FIG. 13, the furler 114 includes a longitudinal
slot 137 that is defined by a pair of spaced-apart fins or tension
tabs 138a, 138b. The tension tabs 138a, 138b define the
longitudinal slot 137 along a center of the furler 114 which
provides a center "lead-in" for the folded mesh 116 into the furler
114 (FIG. 13). Alternatively, at least one of the tension tabs
138a, 138b extends along a tangent of the furler 114 which provides
a tangent "lead-in" for the folded mesh 16 into the furler 114
(FIG. 14).
The longitudinal slot 137 is defined by the tension tabs 138a, 138b
and is wider than the longitudinal slot 37 on the furler 14. This
wideness of the longitudinal slot 137 facilitates inserting the
folded mesh 116 into the furler 114, as the mesh 116 is led into
the furler 114 from the center of the furler 114 or the tangent
along the furler 14 as opposed to the distal end 38 of the furler
14 described above. Moreover, when the tension tabs 138a, 138b are
moved towards one another, the tension tabs 138a, 138b provide an
additional force to the mesh 116, thereby facilitating an even
tighter wind of the mesh 116.
Referring to FIGS. 15-18, a method of use of the endoscopic system
110 is now described. The components of the endoscopic system 110
may be packaged and shipped separately, or together as a kit. In
the latter instance, for example, the kit may include one or more
of the aforementioned radial sleeves or trocar 54, the introducer
112, the furler 114, the sheath 113 and the mesh 116.
The sheath 113 is, initially, positioned on the first shaft portion
124 adjacent a handle 118, with the tines 130a, 130b exposed or
extending distally of the sheath 113 (see FIG. 12 for example). The
mesh 116 may be placed flat between the tines 130a, 130b, with the
tines 130a, 130b in the center of the mesh 116 (FIG. 15). The mesh
116 is then folded in half along the tines 130a, 130b and the mesh
116 is then inserted into the longitudinal slot 137 of the furler
114 (FIG. 16), which can include either of the configurations of
the tensions tabs 138a, 138b shown in FIGS. 13 and 14.
In one hand a surgeon holds the furler 114, and with the other hand
rotates the handle 118 of the introducer 112, thereby rolling or
winding the mesh 116 within the furler 114. The tabbed cut-out 148
can be depressed (as described above) as the mesh 16 is being wound
in the furler 114 to provide a tight wind of the mesh 16.
Alternatively, or in addition thereto, the tension tabs 138a, 138b
can be moved towards one another, which can also facilitate in
providing a tight wind of the mesh 116. Once the mesh 116 is fully
wound, the sheath 113 is moved along the first and second shaft
portions 124, 128 so that the sheath 113 is positioned within the
furler 114 and over the tines 130a, 130b including the wound mesh
116 (FIG. 17). For clarity, the sheath 113 is not explicitly shown
positioned within the furler 114. The introducer 112 including the
sheath 113 with the wound mesh 116 is then inserted into the trocar
54.
As the introducer 112 is being inserted into the trocar 54, the
flared neck portion 140 of the sheath 113 prevents the sheath 113
from going past the trocar 54. As the surgeon continues to insert
the introducer 112 via the handle 118, the tines 130a, 130b advance
the mesh 116 past the sheath 113/trocar 54 and into the abdominal
cavity of the patient, where the mesh 116 naturally unwinds (FIG.
18). At this point the surgeon can use the introducer 112 to
roughly position (e.g., via an articulating portion 126 of the
introducer 112) the mesh 116 for initial tacking, or simply remove
the introducer 112, thereby allowing the mesh 116 to gently drop
into the abdominal cavity.
As can be appreciated, the same advantages described above with
respect to the endoscopic system 10 are attainable with the
endoscopic system 110.
While several embodiments of the disclosure have been shown in the
drawings, it is not intended that the disclosure be limited
thereto, as it is intended that the disclosure be as broad in scope
as the art will allow and that the specification be read likewise.
Therefore, the above description should not be construed as
limiting, but merely as exemplifications of particular embodiments.
Those skilled in the art will envision other modifications within
the scope and spirit of the claims appended hereto.
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